Impact of Quilting Sutures on Surgical Outcomes After Mastectomy: A Systematic Review and Meta-Analysis

Morărașu, Ștefan; Clancy, Cillian; Gheţu, Nicolae; Muşină, Ana Maria; Velenciuc, Natalia; Iacob, Ștefan; Frunza, Tudor; Roată, Cristian Ene; Luncă, Sorinel; Dimofte, Gabriel-Mihail

doi:10.1245/s10434-022-11350-5

Cited by 13 publications

(13 citation statements)

References 42 publications

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“…The incidence of seroma formation decreases by up to 58%. 2,3,[5][6][7][8][9] Various flap fixation methods have been evaluated, including fibrin glue, sclerosants, external pressure garments, and (quilting) sutures. 1,5 As high-level evidence was lacking at the time, a randomized controlled trial was performed by de Rooij et al (the seroma reduction after mastectomy (SAM)-trial).…”

Section: Introductionmentioning

confidence: 99%

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Technical aspects of flap fixation after mastectomy for breast cancer: Guidelines for improving seroma‐related outcome

Weezelenburg

Aldenhoven

Kuijk

et al. 2022

Journal of Surgical Oncology

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Objectives: Previous studies have identified the added value of flap fixation in reducing seroma formation and its sequelae after mastectomy. The seroma reduction after mastectomy (SAM)-trial proved that sutures were superior to tissue glue. In this article, we will elaborate on the results of the SAM-trial to provide a clear surgical guideline.Methods: All patients in the suture flap fixation cohort from the SAM-trial were analyzed if details regarding flap fixation were available. The most optimal number of sutures was determined using a receiving operator characteristics curve. The incidence of seroma formation between patients receiving the most optimal number of sutures and patients receiving fewer sutures was compared. Results:The most optimal number of sutures proved to be 15. Patients with ≥15 sutures had a lower incidence of seroma formation at every time frame during follow-up. There was a significant difference at 6 weeks (odds ratio [OR]: 3.05, 95%

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Section: Introductionmentioning

confidence: 99%

“…Studies have shown that reducing the dead space using flap fixation seems to be the most promising technique at present. The incidence of seroma formation decreases by up to 58% 2,3,5–9 . Various flap fixation methods have been evaluated, including fibrin glue, sclerosants, external pressure garments, and (quilting) sutures 1,5 .…”

Section: Introductionmentioning

confidence: 99%

Technical aspects of flap fixation after mastectomy for breast cancer: Guidelines for improving seroma‐related outcome

Weezelenburg

Aldenhoven

Kuijk

et al. 2022

Journal of Surgical Oncology

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“…Firstly, closed vacuum drainage was developed to limit seroma. In a study published in 1993, patients with skin flap fixation had three times less seroma than other patients 25 . Kuroi et al then affirmed that closing the dead space in the mastectomy area was one of the best ways of preventing seroma 4 .…”

Section: Discussionmentioning

confidence: 97%

“…In their recent meta-analysis, Morarasu et al observed that quilting sutures significantly reduced seroma formation (OR 0.32, 95% CI 0.21-0.49, p < 0.00001) and total volume of drainage (mean difference = 475 ml, 95% CI 337.58-612.40, p < 0.00001) 25 . In this study, quilting was not associated with complications such as surgical site infections, hematoma or flap necrosis 25 .…”

Section: Discussionmentioning

confidence: 99%

Efficacy and aesthetic outcomes for quilting sutures in the prevention of seroma after mastectomy

Foulon

Mancaux

Théret

et al. 2023

Sci Rep

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Worldwide, mastectomy for breast cancer is one of the most frequently performed surgical procedures. As one of the main complications of mastectomy, seroma is associated with pain, infections and a prolonged hospital stay. We performed a prospective multicenter randomized trial to assess the efficacy and esthetic outcomes associated with quilting the skin flap. Eighty-seven patients were included. The proportion of patients with seroma on postoperative day 15 was significantly lower in the quilting group (12 out of 39 (30.8%)) than in a control group with conventional wound closure (21 out of 40 (52.5%); P = 0.05). The mean breast seroma volume was significantly lower in the quilting group (130.2 mL) than in the control group (236.8 mL; P = 0.02). There were no differences in the esthetic outcomes. The pain level on day 1 was similar in the quilting and control groups (mean visual analog scale score: 2.5 vs. 2.1, respectively; P = 0.3). Quilting the skin flap was associated with a lower prevalence of seroma and a lower seroma volume, and did not worsen the esthetic outcomes or pain levels. This technique is technically straightforward and should be offered to all patients scheduled for mastectomy.

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“…Postoperative seroma was also the most common complication in this study (13.0% vs. 16.8%), but its incidence did not signi cantly differ between the two groups. To reduce the incidence of postoperative seroma, the use of QS suture [14,15] and Pseudomonas aeruginosamannose sensitive haemagglutinin (PA-MSHA) [16,17] have been proven effective. On the other hand, some studies have suggested that drainless does not lead to an increase in the incidence of postoperative seroma [18].…”

Section: Discussionmentioning

confidence: 99%

Application of radical mastectomy in ambulatory surgery centres under COVID-19

Zhou¹,

Xiao

Yang

et al. 2022

Preprint

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Background Breast cancer has surpassed lung cancer as the most common cancer. Day surgery for breast cancer has been widely carried out worldwide, but the development of day surgery in China is relatively slow. To reduce the spread of coronavirus 2019 (COVID-19), major surgery centres have optimized the management procedures of day surgery to different degrees. However, relevant research on whether the rapid turnover of day surgery and the excessive human resources placed in the prevention and control of the COVID-19 epidemic will affect the quality of day surgery is lacking. Method The demographic data, clinical data and postoperative complications of breast cancer patients in the single medical group of West China Hospital of Sichuan University from March 2020 to June 2021 were retrospectively collected, and the complications after discharge and the safety of day surgery were analysed. Results The average age significantly differed between the ward surgery group (WS) and the day surgery group (DS) (P = 0.030). Regarding postoperative complications, no significant differences were detected in total surgical complications (P = 0.676) or anaesthesia complications (P = 0.126) between the two groups. In the logistic analysis, day surgery was not a risk factor for postoperative complications during the COVID-19 pandemic (P = 0.676, OR = 1.154, 95% CI: 0.590–2.257). An increase in age significantly increased the incidence of postoperative surgical complications (P = 0.024, OR = 1.051, 95% CI: 1.007–1.097). At the same time, lymph node dissection after sentinel lymph node biopsy also led to an increase in the incidence of postoperative surgical complications (P = 0.030, OR = 3.372, 95% CI: 1.125–10.106). In the survival curve, no significant difference in DFS was detected between the two groups (P = 0.353). Conclusion Radical mastectomy at day surgery centres is safe and reliable under strict COVID-19 management guidelines.

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Impact of Quilting Sutures on Surgical Outcomes After Mastectomy: A Systematic Review and Meta-Analysis

Cited by 13 publications

References 42 publications

Technical aspects of flap fixation after mastectomy for breast cancer: Guidelines for improving seroma‐related outcome

Technical aspects of flap fixation after mastectomy for breast cancer: Guidelines for improving seroma‐related outcome

Efficacy and aesthetic outcomes for quilting sutures in the prevention of seroma after mastectomy

Application of radical mastectomy in ambulatory surgery centres under COVID-19

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